New cancer care proves to be more effective, but it carries steep new costs

Targeted but expensive chemotherapy treatments for cancer at Rhode Island hospitals are changing the way the disease is treated in the Ocean State, with the result being increased survival rates for patients.
The costs, however, can be prohibitive, with two-week prescriptions for the chemo drugs running as high as $1,300. As health care reform unfolds, it’s unclear whether federal law will address and respond to the new changes in treatment – and help lessen the burdensome costs.
The American Cancer Society on June 2 released its national statistics on cancer and mortality for 2010, showing 5,970 estimated new diagnosed cases of cancer for Rhode Island, with 2,170 estimated deaths. Compared with the 2005 figure, the incidence of cancer in Rhode Island has risen slightly from 5,870, while deaths decreased from 2,440.
For Kevin Kurowski, 58, of Barrington, such statistics have taken on a personal meaning: He was diagnosed with leukemia in July 2009, one of 160 such cases in Rhode Island currently, according to the recently released statistics. After a year-long series of chemotherapy regimens at Rhode Island Hospital and its Comprehensive Cancer Center, his bone marrow is cancer-free and the disease is in remission.
To treat his diagnosed acute promyelocytic leukemia, a cancer of the blood and bone marrow, Dr. David Berz, an oncologist at Rhode Island Hospital, employed both oral and intravenous doses of ATRA, a retinoid related to Vitamin A, as well as blood transfusions. The side effects included severe headaches, the onset of hiccups and mouth sores.
Kurowski also received arsenic trioxide from an IV – what he termed “rat poison” – for seven weeks, five days a week, two hours a day, on an outpatient basis at the Comprehensive Cancer Center. “I sat in a recliner, plugged into the IV,” he said.
Today Kurowski, laid off since August 2008 from his job as a lab technician for Interplex Metals in Providence, is still taking ATRA as a maintenance program. “Even though I’m in remission, I take it as an insurance policy.” Beyond what his medical insurance covered, Kurowski ended up owing Rhode Island Hospital about $127,000 in medical costs for his treatment, which he is paying off on a monthly basis.
The prescription for ATRA runs $1,300 for two weeks – about $2,600 a month, and it has to be dispensed at a special pharmacy at Rhode Island Hospital. Kurowski said he has been trying every avenue to get some relief from the cost of the ATRA chemotherapy, to no avail.
“One of the doctors told me: ‘That’s more than my monthly mortgage,’ ” Kurowski said.
Dr. Eric Winer, an assistant professor at the Warren Alpert Medical School at Brown University, whose expertise is malignant hematology, is currently treating Kurowski on an outpatient basis. “What’s really changed,” he said, describing the advances in chemotherapy to treat leukemia and lymphoma, “is that we’re better at identifying the different types of leukemia and making better prognoses.”
The evolution in cancer treatment is three-fold, Winer continued. The science has progressed from looking at cells under a microscope, to identifying chromosomes to now targeting proteins which are the root causes of the disease, he said. “Now that we know more about the individual cancer cell and the individual proteins that cause the cancer, we can attack the surface molecules of the cell,” Winer said.
As a result, new drug treatments such as ATRA can be successful in destroying the disease-causing proteins, increasing the survival rate, with less toxicity compared to chemotherapy from years before which attacked all fast-growing cells, and led to severe nausea and hair loss.
About four of every 10 people in Rhode Island will develop cancer sometime in the course of life, according to the 2008 report, “Rhode Island’s Cancer Burden,” published by the R.I. Department of Health and the Rhode Island Cancer Registry. The report says that about 43,000 residents, about 4 percent of the state’s population, are currently “surviving” with cancer. The total costs of cancer in Rhode Island are about $933 million a year, including $379 million in direct medical costs, $77 million in lost productivity due to illness and $477 million in lost productivity due to premature death, according to the report, based upon American Cancer Society estimates of costs nationwide.
“With a population that is both growing and aging, even if the cancer rates remain stable, the number of people diagnosed with cancer is expected to increase,” according to the report.
Hospitals are developing a more multidisciplinary approach to treatment, according to Dr. Michael Dacey, senior vice president and chief medical officer at Kent Hospital in Warwick. “We have just started a combined breast health center to treat patients … in a multidisciplinary manner,” Dacey said.
Kent Hospital sees about “650 new cancer patients a year,” with about 1,200 patients receiving treatment each year, according to Dacey. Kent doesn’t treat leukemia patients, which along with lymphoma patients are most often treated in Providence at Rhode Island Hospital or Roger Williams Medical Center. The most common types of cancer in Rhode Island, Dacey said, are lung, breast and colon cancers.
Another big change in cancer treatment is the ability of cancer patients to participate in clinical trials of new drugs, Dacey said.
About 5 percent of patients at Kent Hospital choose to participate in clinical trials, part of Kent’s clinical-trial support unit, enabling patients to access these larger networks. There are many resources online for patients to learn more about such clinical trials, including one run by the National Cancer Institute, Dacey said. At Memorial Hospital in Pawtucket, Dr. Anthony G. Thomas directs the hospital’s hematology and oncology department and oversees its cancer center. He is excited about a new protocol to be offered at the hospital, the first in Rhode Island to do so, for breast cancer patients. The new protocol, one of 20 to 30 protocols for new treatments for cancer now offered at Memorial, involves an antibody, Denosumad, with the potential to block the spread of cancer and increase survival.
But cost remains a major drawback of the new drug therapies for cancer, as Kurowski has experienced.
“The drugs are significantly expensive,” said Winer. “Doctors don’t regulate what the drug companies charge for the drugs. That’s far more of a public health issue,” he said.
It remains unclear whether patients such as Kurowski, who are using successful cancer treatment drugs which emerged from successful clinical trials, will receive any financial support or benefits from the new federal health reform law.
Beginning in January 2014, health insurers and self-funded plans will be required to cover the routine costs for federally funded, clinical-trial participants, according to Kimberly R. Reingold, director of media relations and external affairs at Blue Cross & Blue Shield of Rhode Island. No guiding regulations currently exist, she said, but Reingold says that such guidelines may be issued in the next four years.
According to BCBSRI, clinical trials are defined as “Phase I, II, III or IV clinical trials for the prevention, detection or treatment of cancer or other life-threatening disease or condition,” and routine costs are defined in broad terms as “items and services consistent with coverage provided for qualified individuals.” •